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Giving factor through a subcutaneous port

You have been asked to start giving your child factor at home through a subcutaneous port. This will tell you how to place a needle in the port, infuse (give) the factor medicine, and remove the needle from the port when you are finished.

Know the medicine

Before giving any new medicine to your child, read the “Patient Medication” handout for the medicine. Or ask your child’s doctor, nurse or pharmacist these questions:

What are the possible side effects of this medicine? And what do I do to lessen those?

What should I do if my child has a bad reaction?

How should I store this medicine? Keep all medicines out of children’s reach.

Getting ready

Pick a well lit work area.

Clean and disinfect your workspace. Use an alcohol prep pad or antibacterial cleaner.

Fill another 10ml syringe with the correct amount of heparin. Your doctor or nurse will tell you how much and which strength of heparin you should be using.

Mix the factor with the diluent according to package insert.

Fill the empty syringe with the correct amount of factor.

Check the syringes of saline, heparin, and factor for air bubbles.

With the needle pointing upward, gently tap the syringe with your hand to make the air bubbles float to the top.

Then, use the plunger to push the air out until you see a drop of fluid at the top of the needle.

Place each syringe back in the clear package so it will remain clean.

Placing the huber needle in the port

Open the package containing the huber needle. Keep the package to use as a clean tray.

Pick up the end of the tubing that has the yellow end with the white cap. Remove the white cap. Do not touch the yellow end of the tubing.

Pick up one (1) of the syringes that contains 5ml of saline. Twist off the needle. Attach the syringe to the end of the tubing. Push a little saline into the tubing until you see it come out of the huber needle. Lay the tubing back down in the package.

Feel the location of the port with two fingers, placing them on both sides of the port. Have your child lie down if needed to feel the port.

Clean the port site with the Chloraprep applicator:

Pinch the wings of the applicator to release the solution; you should hear it pop.

Press the sponge to the center of the port site.

Using an up and down then back and forth motion, cover about 3 inches for about 30 seconds.

Allow the skin to air dry completely, do not blow on the site.

Open the package of sterile gloves. Put on the gloves. See “Do you know… How to put on sterile gloves” if needed. Pick up the huber needle and remove the cover. Do not touch the needle. Fold back the plastic wings and hold the needle by the wings.

Place the fingers of your other hand on each side of the port, holding it firmly between your fingers. Insert the huber needle straight down into the port, pushing firmly until you feel the needle touch the back of the port. Do not tilt or rock the needle in the port. When you feel the needle touching the back of the port, stop pushing on the needle.

Pull back on the plunger of the syringe until you see blood. Push 4ml of saline into the port, using a pulsing motion. While flushing with the last 1 ml of saline, close the clamp. The port should be easy to flush. Do not force it. If the line will not flush, check to make sure the clamp is open and that the tubing is not kinked. If you still cannot flush the port, please call your clinic.

Giving the factor

Remove the first saline flush from the line. Do not lay the end of the tubing down.

Clean the end of the line with alcohol for 7 seconds. Let it dry for 7 seconds. Do not blow on the tubing.

Pick up the syringe containing factor and twist off the needle.

Attach the syringe to the tubing. Open the clamp.

Slowly push the factor into the line. Close the clamp.

Remove the factor syringe from the line.

Clean the end of the tubing again with alcohol for 7 seconds. Let it dry for 7 seconds. Do not blow on the tubing.

Pick up the second saline syringe and twist off the needle.

Attach the saline flush to the line. Open the clamp.

Slowly flush the saline into the line, using a pulsing motion. While flushing in the last 1ml of saline, close the clamp.

Remove the saline syringe from the line.

Clean the end of the tubing again with alcohol for 7 seconds. Let it dry for 7 seconds. Do not blow on the tubing.

Pick up the heparin syringe and twist off the needle.

Attach the heparin syringe to the line. Slowly push the heparin into the line, using a pulsing motion. As you push the last 1ml of heparin into the line, close the clamp. This leaves a positive pressure in the line.

Removing the needle from the port

Place the needle remover on top of the port, and apply gentle downward pressure. Remove the needle from the port with your other hand, grasping the wings and pulling straight up and out. Stick the needle into the handle of the needle-removing device for disposal.

Use a gauze pad and hold pressure over the port where the needle was. Hold pressure until bleeding stops. Cover the site with a self-stick bandage.

Place needle in your sharps container. See “Do you know…Throwing away sharp objects safely.” Dispose of other used supplies in the regular trash.

Wash your hands.

Tips and troubleshooting

Before you place the huber needle in your child’s subcutaneous port, make sure you have the proper supplies. If you are running low on any supplies, please tell your clinic nurse and the supplies can be ordered for you.

Think through the process of placing the needle before you begin. Read through the procedure in this document and prepare your supplies.

Only a huber needle should be used in the port. Never allow anyone to insert a regular needle into the port. It could damage the port.

Remember to report signs and symptoms of infection (redness, swelling, drainage, or fever) to the doctor.

Problem: Trouble feeling the port under the skin

Take your hand and feel for all the edges of the port before you clean. If you cannot feel the edges, then reposition your child (lay him down, or sit him up if he is already lying down).

If you are still having trouble finding the subcutaneous port, please call the clinic or a line nurse for help.

Problem: The huber needle is in the port, but I cannot flush.

Ask yourself these questions: Did I feel the needle go through the port? Did the needle hit the back of the port? If you answered no, then you may not be in the port or you may have to push the needle further into the port to hit the back of the port.

Feel the sides of the port to make sure you are in the center of the port. If you are not center, you might need to try placing the needle again.

Look and see if you opened the clamp on the line.

You may also turn the needle in a circular motion to see if you can flush. Do not pull the needle out of the port or skin when you do this.

If the wings of the needle are pressed to the skin, you may need a longer needle. Please talk to a line nurse about this.

Sometimes there is a clot in the port. The patient would need to come in to the clinic to be examined.

NEVER force a flush into the port.

Problem: I have placed the needle and can flush the port, but there is no blood return.

Ask your child if it hurts when you flush. If it is hurting your child, the needle may not be in the port. Check the needle placement.

If it does not hurt your child when you flush, use a pulsing flush with saline. You may need to try several saline flushes and pull back slowly to check for blood return.

Reposition your child. Try moving from sitting up to lying down or vice versa. Sometimes it can help for the patient to cough, lean forward, or put his arms up or down.

If the port is flushing and your child is not complaining of pain, please call the clinic or a line nurse for help.

Questions?

If you have questions or concerns about giving factor at home through a port, please call the Hematology clinic at 901-595-5041. If you are calling after hours or on the weekend, dial 901-595-3300 and ask for the nursing coordinator or the doctor on-call. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833) and press 0 when the call connects.

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).